Impact of vascular risk factors on clinical outcome in older patients with depression receiving electroconvulsive therapy

Abstract

Introduction Despite electroconvulsive therapy (ECT) is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients, response rate highly varied across individuals. We hypothesized that, as seen with medication, vascular burden may in part explain those discrepancies. Objective The aim of this study was to compare response rates to ECT in elderly depressed patients presenting or not vascular risk factors (VRF). Method In a retrospective study, 54 elderly patients (age > 55; mean age 60.7 ± 13.6) with moderate to severe MDD (Montgomery–Asberg Depression Rating Scale MADRS score > 20) who received a course of ECT between March 2016 and May 2018 in our specialized unit were separated into 2 groups according to VRF. Patients of the VRF group (n = 21) should presented with at least 2 vascular risk factors among hypercholesterolemia, hypertension, smoking, diabetes mellitus, cardiovascular disease, and cerebral vascular accident/transient ischemic attack. Framingham score (10-year risk for developing a coronary heart disease) was calculated for each included subject. Our primary outcome was the number of responder to ECT (defined as 50% decrease of the MADRS following ECT course) observed between the two groups. As a secondary objective, we investigated the relationship between Framingham score and pre/post ECT MADRS score changes. Results There was no difference between the 2 groups regarding age, gender, cognitive functioning, depression severity, stage of treatment-resistant depression and illness duration. Elderly patients with vascular burden presented a lower rate of response to ECT (58.1%) than patients without vascular burden (86.7%; Chi2 = 5; P = 0.02). A negative correlation was found between Framingham score and pre/post ECT MADRS score changes (r = −0.39; 95% CI − 0.61–0.12; P = 0.01). Conclusion As observed with medication, elderly patient with vascular burden displayed a lower response rate to ECT than elderly patients without vascular burden. The more VRF increased, the less the antidepressant effect of ECT was observed.